Renal Considerations in Critical Limb Ischemia View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2017

AUTHORS

Pranav Sandilya Garimella , Amit M. Kakkar , Prakash Muthusami

ABSTRACT

Peripheral artery disease (PAD) and its consequent critical limb ischemia (CLI) are commonly seen with increasing age in the general population. PAD patients present on a spectrum ranging from intermittent claudication to CLI, which is the most devastating outcome with high rates of mortality and morbidity including limb loss. The current TransAtlantic Inter-Society Consensus (TASCII) guidelines define CLI as a complex devastating syndrome that manifests as (1) ischemic rest pain, (2) ulcers, or (3) gangrene, attributable to arterial occlusive disease. Persons with chronic kidney disease (CKD) especially those with end-stage renal disease (ESRD) on dialysis have significantly higher rates and severity of disease compared to age-matched population controls. Over- and above-traditional PAD risk factors like diabetes, hypercholesterolemia, smoking, and age, persons with kidney disease have a unique set of conditions including uremic stress, chronic inflammation, hypoalbuminemia, and a predisposition to vascular calcification which may accelerate the natural progression of PAD. Patients with CKD often develop CLI with poorer outcomes despite therapy. Both endovascular and open surgical procedures in CKD are associated with higher rates of loss of patency, infections, and amputations when compared to non-CKD persons. However, any revascularization procedure for CLI in patients with kidney disease is associated with improved outcomes compared to non-revascularization. This chapter reviews the epidemiology, disease burden, risk factors, clinical features, and therapeutic options and outcomes of CLI in persons with kidney disease and dialysis. We will also discuss hemodialysis access-related steal syndromes, a form of limb ischemia unique to persons on dialysis. More... »

PAGES

561-570

Book

TITLE

Critical Limb Ischemia

ISBN

978-3-319-31989-6
978-3-319-31991-9

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-31991-9_50

DOI

http://dx.doi.org/10.1007/978-3-319-31991-9_50

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1040051579


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    "description": "Peripheral artery disease (PAD) and its consequent critical limb ischemia (CLI) are commonly seen with increasing age in the general population. PAD patients present on a spectrum ranging from intermittent claudication to CLI, which is the most devastating outcome with high rates of mortality and morbidity including limb loss. The current TransAtlantic Inter-Society Consensus (TASCII) guidelines define CLI as a complex devastating syndrome that manifests as (1) ischemic rest pain, (2) ulcers, or (3) gangrene, attributable to arterial occlusive disease. Persons with chronic kidney disease (CKD) especially those with end-stage renal disease (ESRD) on dialysis have significantly higher rates and severity of disease compared to age-matched population controls. Over- and above-traditional PAD risk factors like diabetes, hypercholesterolemia, smoking, and age, persons with kidney disease have a unique set of conditions including uremic stress, chronic inflammation, hypoalbuminemia, and a predisposition to vascular calcification which may accelerate the natural progression of PAD. Patients with CKD often develop CLI with poorer outcomes despite therapy. Both endovascular and open surgical procedures in CKD are associated with higher rates of loss of patency, infections, and amputations when compared to non-CKD persons. However, any revascularization procedure for CLI in patients with kidney disease is associated with improved outcomes compared to non-revascularization. This chapter reviews the epidemiology, disease burden, risk factors, clinical features, and therapeutic options and outcomes of CLI in persons with kidney disease and dialysis. We will also discuss hemodialysis access-related steal syndromes, a form of limb ischemia unique to persons on dialysis.", 
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